This cross-sectional economic evaluation followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline and applicable elements of the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) reporting guideline.17 This analysis used the societal perspective: tangible and intangible costs to multiple payers. All costs are reported as 2019 US dollars. Annual estimates used a 1-year time horizon and per affected person lifetime estimates were based on annual costs in combination with average US life expectancy. This study used publicly available data; it did not constitute human research and does not require institutional review board review or exemption according to the Common Rule (45 CFR §46). This study comprised an original analysis of the most comprehensive cross-sectional survey data source in the US for ACEs and adult health outcomes: the Behavioral Risk Factor Surveillance System (BRFSS).15,18 The BRFSS is an annual, random-digit-dialed landline and mobile telephone survey of noninstitutionalized US adults. Overall, 418 461 persons participated in the 2019 and 402 212 in the 2020 BRFSS surveys (median state-level response rates: 49.4% vs 47.9%).19
